B-2016-2202 CITY OF 1CUPERIENO BUILDING PERMIT
BUILDING ADDRESS: I CONTRACTOR: PERMIT NO:B-2016-2202
1113 STEEPLECHASE IN CUPERTINO,CA 95014-5816(359 31(46) THD AT-HOME
SERVICES INC
ATLANTA,GA 30339
OWNER'S NAME: TRAN YEN T N TRUSTEE DATE ISSUED:06/23/2016
OWNER'S PHONE:303-990-2633 I PHONE NO:(770)779-1423
LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO:
License Class B C-39,C-13.C-17 Lic.#836021
Contractor THD AT-HOME SERVICES INC Date 04/30/2018 X BLDG —ELECT —PLUMB
I hereby affirm that I am licensed under the provisions of Chapte 9(commencing MECH X RESIDENTIAL_COMMERCIAL
with Section 7000)of Division 3 of the Business&Professions Coe and that my
license is in full force and effect. JOB DESCRIPTION:
REMOVE/REPLACE PATIO DOOR(1)-DINING ROOM
I hereby affirm under penalty of perjury one of the following twodeclarations:
t. I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. Sq.Ft Floor Area: Valuation:$1936.00
APPLICANT CERTIFICATION
I certify that I have read this application and state that the abov
information is correct.I agree to comply with all city and county ordinances Number: Occupancy Type:
359
and state laws relating to building construction,and hereby authorize 359 31 046
representatives of this city to enter upon the above mentioned property for
inspection purposes. (We)agree to save indemnify and keep h rmless the
City of Cupertino against liabilities,judgments,costs,and expenses which PERMIT EXPIRES IF WORK IS NOT STARTED
may accrue against said City in consequence of the granting of his permit. WITHIN 180 DAYS OF PERMIT ISSUANCE OR
Additionally,the applicant understands and will comply with allIon-point 1-_1
source regulations per the Cupertino Municipal Code,Section 9,18. 180 DAYS FROM LAS; E' INSPECTION.
Signature Date 6/23/2016 Issued by:Alex Vallelunea /�
Date:06/23/2016 r
Y V.
OWNER-BUILD
L
I hereby affirm that I am exempt from the Contractor's License Law for one of the RF ROOFS:
following two reasons: I All roofs shall be inspected prior to any roofing material being installed.If a roof is
t. I,as owner of the property,or my employees with wages a$their sole installed without first obtaining an inspection,I agree to remove all new materials for
compensation,will do the work,and the structure is not int nded or offered for inspection.
sale(Sec.7044,Business&Professions Code)
z. I,as owner of the property,am exclusively contracting with licensed Signature of Applicant:
contractors to construct the project(Sec.7044,Business&professions Code). Date:6/23/2016
I hereby affirm under penalty of perjury one of the following three declarations: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1. I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Lab r Code,for the
performance of the work for which this permit is issued. HAZARDOUS MATERIALS DISCLOSURE
2. I have and will maintain Worker's Compensation Insw ,as provided for by I have read the hazardous materials requirements under Chapter 6.95 of the
Section 3700 of the Labor Code,for the performance of the work for which this California Health&Safety Code,Sections 25505,25533,and 25534. I will
permit is issued. II maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
3. I certify that in the performance of the work for which this}termit is issued,I Health&Safety Code,Section 25532(a)should I store or handle hazardous
shall not employ any person in any manner so as to becorn subject to the material. Additionally,should I use equipment or devices which emit hazardous
air contaminants as defined by the Bay Area Air Quality Management District I
Worker's Compensation laws of California. If,after making this certificate of will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
exemption,I become subject to the Worker's Compensatiorj provisions of the the Health&Safety Code,Sections 25505,25533,and 25534.
Labor Code,I must forthwith comply with such provisions for this permit shall
be deemed revoked. Owner or authorized agent:
APPLICANT CERTIFICATION Date:6/23/2016
I certify that I have read this application and state that the above information is CONSTRUCTION L AGENCY
correct.I agree to comply with all city and county ordinances an state laws I hereby affirm that there is a constructiorl�l ding agency for the performance
relating to building construction,and hereby authorize represents tives of this city of work's for which this permit is issued(Sec.3097,Civ C.)
to enter upon the above mentioned property for inspection purposes. (We)agree Lender's Name
to save indemnify and keep harmless the City of Cupertino against liabilities,
judgments,costs,and expenses which may accrue against said City in Lender's Address
consequence of the granting of this permit. Additionally,the app icant understands
and will comply with all non-point source regulations per the Cu ertino Municipal ARCHITECT'S DECLARATION
Code,Section 9.18. 1 understand my plans shall be used as public records.
Licensed
Signature Date 6/23/2016 Professional
CONSTRUCTIO PERMIT APPLICATION
Is COMMUNITY DEVELOPMEI NT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228•FAX(408)777-3333•building(ftupertino.org /„'��o
v
❑NEW CONSTRUCTION ❑ ADDITION ❑ ALTERATION/TI ❑ REVISION/DEFERRED ORIGINAL PERMIT#
PROJECT ADDRESS1 / 1 (✓��' /,r� �� / , a APN# � /�
OWNERNAME L( /J 7K A�L: —T (rP &MAIL
STREET ADDRESS 1113 G C r CI( �1�L2�/�O G g J FAX
CONTACTNAME JEFF RAINEY / C PHONE 510-427-4260 E-MAILJKEFFREY.RAINEY@ATT.NET
STREET ADDRESS 1069 EDGEMERE LANE CITY,STATE,ZIP HAYWARD, CA 94545 FAX 510-783-1041
❑OWNER ❑ OwNER-BUILDER ❑ OWNER AGENT ❑ CONT] ACTOR -13 CONTRACTOR AGENT 11 ARCHITECT 11 ENGINEER El DEVELOPER 1:1 TENANT
CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC#
836021 B,C39,C13,C17
COMPANY NAME E-MAIL FAX
THD AT HOME SERVICES 510-357-3750
STREET ADDRESS CITY,STATE,ZIP PHONE
' 2456 VERNA COURT SAN LEANDRO,CA 94577 510-877-4550
ARCHITECT/ENGINEER NAME ICENSE NUMBER BUS.LIC#
COMEANY NAME E-MAIL FAX
STREET ADDRESS I CITY,STATE,ZIP PHONE
DESCRIPTION OF WORK P `` r /, !Q F'1,cs�A2 1J0 D
EXISTINGUSE PROPOSED USE CONSTR.TYP #STORIES I
USE TYPE OCC. SQ.FT. VALUATION($)
EXISTG NEWFLOOR DEMO TOTAL
AREA AREA AREA T AREA
BATHROOM KITCHEN OTHERI
REMODELAREA REMODELAREA REMODEI.�REA
PORCH AREA DECK AREA TOTAL DECK/PORCH AREA GARAGE AREA: EIDETACH
❑ATTACH
#DWELLING UMTS: IS A SECOND UNIT ❑YES SECOND STORY ❑YES
BEING ADDED? ❑NO ADDITION? []NO
I 1 �-
PRE-APPLICATION ❑YES IF YES,PROVIDE COPY OF is THE B�DG AN ❑YES RECEIVED TOTAL VALUA ION:
PLANNINGAPPL# []NO PLANNING APPROVAL LETTER EICHLE HOME? []NO
By my signature below,I certify to each of the following: I am the roperty owner or authorized ag nt t on ffe property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I autho ntatives of Cupertino to enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: I Date: 2�
SUPPLE NT ORMATION REQ
PLAN`CHECKTYPE,`.` RQUTINGSLIP
_New SFD or Mu 'amity dwellings: Apply o iti n permit for OVER THE COUNTER ❑ BUUAD GPLAN REVIEW
existing building(s). Demolition permit is required prior to i suance of building "'• 7
permit for new building. ❑ EXPREss '" D".,PLANNING'PLAN REVIEW131
"
_Commercial Bldgs: Provide a completed Hazardous Ma erials Disclosure ❑'sTANDARD ❑,PUBLIC WORKS
form if any Hazardous Materials are being used as part of thi�project. x a I
L� I ARGE a a ❑ it DEPT
_Copy of Planning Approval Letter or Meeting with Planning prior to ❑;MAJOR" Elt SANITARY'SEW GR"DISTRICT"'
submittal of Building Permit application.
❑,'ENVIRONMENTAL HEALTH
B1dgApp 2011.doc revised 06/21111
LEGEND: SCOPE OF WORK:INSTALL(1)RETROFIT VINYL,DUAL =
® = RETROFIT WINDOW/PATIO DOOR/ENTRY DOOR LOCATION GLAZED,LOW E,PATIO DOOR.NO(N)CONSTRUCTION,
FRAME WILL NOT BE DISTURBED. OLO
ti
s NOTE;WINDOWS/PATIO/ENTRY DOORS; cry rn
COMN4UNITY DEVELOFIVIENT DEPA "MENT
U-FACTOR=0.30 CD w
BUILDING DIVISION-CUPERT14 � SHGC=0.25 �U U
C:)
be kept at the w L
TI s c,t of dans and specifications MUS
si' c�uririq construction. It is unlawii to make any C>Q
r h,-;.nabs or alterations on same',or A deviaio
I. >:' rc++,�,,without approval from the B i ding Official. Q N z
DINING ROOM r C I , �
TF :,-impi g of this plan ands +' ati+�e.s SFiA! NOT DINING ROOM PATIO DOOR
3 �Id to permit or c be,an ,p roval+ the viol c}ion 69"w x 79"h
y provisions r r� �i J din- c r State Law. JUN 3 9
PI PIR1i i NO. �ge
E
O�
KITCHEN
'e
z �~
GARAGE
PLOT PLANS CH ENTRYCD
J T
ED �� cco M
DATE 6 2LU
a
PLANNING DEPT � w z
C',UPERTINQGLE STORY HOME (FRONT YARD) LU
FLOOR PLAN Ccl STEEPLECHASE LANE M
V
NOTE: '-
1).SMOKE DETECTORS:WHEN A BUILDING PERMIT IS REQUIRED,SMOKE DETECTORS SHALL BE INSTALLED;(a)IN EACH SLEEPING ROOM,(b)OUTSIDE EACH SEPARATE SLEEPING AREA IN THE IMMEDIATE VICINITY OF THE DATE 06.13.16
BEDROOMS,(c)ON EACH ADDITIONAL STORY OF THE DWELLING,INCLUDING BASEMENTS AND HABITABLE ATTICS BUT NOT INCLUDING CRAWL SPACES AND UNINHABITABLE ATTICS.(CRC 314)
SCALE NTS
2).CARBON MONOXIDE ALARMS:WHERE A PERMIT IS REQUIRED FOR ALTERATIONS,REPAIRS OR ADDITIONS EXCEEDING$1,000.00,EXISTING DWELLINGS OR SLEEPING UNITS THAT HAVE ATTACHED GARAGES OR FUEL BURNING Ommsr DKW
APPLIANCES SHALL BE PROVIDED WITH A CARBON MONOXIDE ALARM IN THE FOLLOWING LOCATIONS;(a)OUTSIDE OF EACH SEPARATE DWELLING UNIT SLEEPING AREA IN THE IMMEDIATE VICINITY OF THE BEDROOM(S),(b)ON
EVERY LEVEL OF A DWELLING UNIT INCLUDING BASEMENTS.(CBC 420.4,CRC R315). JOB ' 9337563
s�Er
(HOME OWNER TO PROVIDE BEFORE FINAL INSPECTION). A-1
F
SMOKE / CARBON MONOXIDE ALARMSI i
OWNER CERTIFICATE OF COMPLIANCE RIS
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
CUPERTINO 10300 TORRE AVENUE-CUPERTINO,CA 95014-3255
(408)77-7-3228•FAX(408)777-3333• building(c)-cupertino.org
Permit No.
Address %l f dLc - Lr tt-9 #of Alarms Smoke: Carbon Monoxide:
PERMIT CANNOT Sj S CERTIFICAT r {
F SABN R TURFED TUHBUILDING DI�ISUN
14
-
PURPOSE
This affidavit is a self-certification for the installation of all required Smoke and Carbon Monoxide Alarms for
compliance with 2013 CRC Section R314,2013 CBC Sections 420.6 and 907.2.11.2 where no interior access for
inspections are required.
GENERAL INFORMATION
Existing single-family and multi-family dwellings shall be provided with Smoke Alarms and Carb_n
Monoxide alarms. When the valuation of additions,alterations, or repairs to existing dwelling units exceeds
$1000.00,CRC Section R314 and CBC Sections 907.2.11.5 and 420.6 require that Smoke Alarms and or Carbon
Monoxide Alarms be installed in the following locations:
AREA SMOKE ALARM COALARM
Outside of each separate sleeping area in the immediate vicinity of the X X
bedroom(s)
On every level of a dwelling unit including basementsX X
Within each sleeping room � X
Carbon Monoxide alarms are not required in dwellings which do not contain fuel-burning appliances and that
do not have an attached garage. Carbon monoxide alarms combined with smoke alarms shall con iply with
CBC Section 420.6 and shall be approved by the Office of the State Fire Marshal.
Power Supply:In dwelling units with no commercial power supply, alarm(s)may be solely batter operated.
In existing dwelling units, alarms are permitted to be solely battery operated where repairs or alterations do
not-result in the removal of wall and ceiling finishes or there is no access by means-of attic,basement or crawl
space.Refer to CRC Section R314 and CBC Sections 907.2.11.4 and`420:6.2.An electrical permit is required for
.alarms which must be connected to the building wiring.
As owner of the above-referenced property,I hereby certify that the alarm(s)referenced above has have been
installed in accordance with the manufacturers instructions and in compliance with the CaliforniaBuilding
and California Residential Codes.The alarms have been tested and are operational, as of the date signed
below.
l have read and a ree to comply with the terms and conditions of this statement
Owner(or Owner Agent/'s)Name:
re ... „��`� ate:
Si natu :.f/6
Contractor Name:
Sinature...................................................................Lic.#...................................... ate: ...................
Smoke and CO form.docrevised 03118114
WATER-CONSERVING PLUMBING FIXTURESRF�11
OWNER CERTIFICATE OF COMPLIANCE
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•building(ftupertino.org �—9
a
Owner Name �ZA� Permit No.
Address �ch c- 4 C I
1. Is your real property a registered historical site?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
No Go to Question 2,
2. Does your real property have a licensed plumber certifying that,due to the age or configuration of the property oi its
plumbing,installation of.water-conserving plumbing fixtures is not technically feasible?
Yes Civil Code Sections 1101.1 through 1101.8 do not apply.
J The licensed pluinber's certification has been provided to the Building Division.
Skip the rest of the form and sign bottom of form.
ted No Go to Question 3.
3. Is water service permanently disconnected for your building?
❑ Yes Civil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the forin and sign bottom of form.
No Go to Question 4.
4. Is your real property built and available for use or occupancy on or before January 1, 1994?
❑ No My real property is built and available for use or occupancy after January 1,1994.
Cavil Code Sections 1101.1 through 1101.8 do not apply. Skip the rest of the form and sign bottom of form.
IX Yes My real property is built and available for use or occupancy on or before January 1, 1994.
Civil Code Sections 1101.1 through 1101.8 apply. Check one of the three following statements and sign
bottom of form..
5. Please check ONE of the following:
EX My property is a single-family residential real property. See Civil Code Section 1101.4.
On and after January 1, 2014,building alterations or improvements shall require all non-compliant plumbin fixtures
to be replaced with water-conserving plumbing fixtures throughout the building.On or before January 1,2017,all non-
compliant plumbing fixtures shall be replaced with water-conserving plumbing fixtures (regardless of whether
property undergoes alterations or improvements)
El My property is-a multifamily residential real property. See Civil Code Section 1101.5.
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1,2019,all non-compliant plumbing fixtures shall be replaced with water-
conserving plumbing fixtures throughout the building(regardless of whether property undergoes alterations o
improvements).
❑ My property is a commercial real property. See Civil Code Section 1101.5.
On and after January 1,2014,specified building alterations or improvements shall require non-compliant
plumbing fixtures to be replaced with water-conserving plumbing fixtures.
On or before January 1, 2019, all non-compliant plumbing.fixtures shall be replaced with water- cons rving
plumbing fixtures throughout the building(regardless of whether property undergoes alterations or improvements).
1,as the owner or owner's agent of this property,certify under penalty of perjury that non-compliant plumbing fixtures will be
replaced prior to date specified above with water-conserving plumbing fixtures in accordance with Civil Code Sections 1101.1
through 1101.8,the current California Plumbing Code and California Green Building Standards Code,and manu acturer',s
installation requirements,and that the water-conserving plumbing fixtures comply with the requirements as indicated in the
table on the following page.
Owner or Owner Agent's Signature: Date: /-6
Upon completing and signing this Certif Cate,please return it to the Building Division in order to final your building permit.
SB40 7 2015.doc revised 08126115